Impact of an alarm device on medication compliance in women in Mombasa, Kenya.

A randomized controlled clinical trial was conducted to determine the efficacy and acceptability of an alarm device for improving medication compliance among women in resource poor countries. Study participants were given a one-month supply of daily multi-vitamins in an electronic medication vial. Women randomly received either an alarmed vial or a non-alarmed vial. Sixty per cent of women had good compliance (defined as 95% > or = of pills ingested). Women randomized to use the alarmed vial were significantly more likely to have good compliance than those in the non-alarmed control group (82% vs. 36%, P < 0.001). Vial acceptability was high and 99% of participants said they would choose to use the vial again. In conclusion, the alarm device was found to significantly improve medication adherence rates and may be particularly beneficial for improving adherence to antiretroviral therapy among HIV-1 infected persons in developing countries.

Prevalence of antimicrobial drug-resistant Streptococcus pneumoniae in Washington State.

We conducted a survey to assess the prevalence and geographic distribution of antimicrobial drug resistance among invasive isolates of Streptococcus pneumoniae in Washington State. Sequential sterile-site pneumococcal isolates were submitted from 13 hospital laboratories between 1 October 1995 and 30 January 1997. We serotyped 275 isolates from adults and children and determined minimum inhibitory concentrations (MIC) for commonly used antimicrobial drugs. Data were abstracted from medical records to compare differences in outcome and risk factors for infection. Of the 275 isolates, 73 (26.5%) were nonsusceptible to one or more antimicrobial drugs. Penicillin-nonsusceptible pneumococci (PNSP, MIC > or = 0.1 microgram/ml) accounted for 42 (15.3%) of the 275 isolates including 4 (1.5%) resistant strains (MIC > or = 2 micrograms/ml). The 42 PNSP included serogroups 6, 9, 14, 19, and 23, all of which are represented in the 23-valent pneumococcal vaccine. PNSP were also nonsusceptible to trimethoprim/sulfamethoxazole (92.9%), erythromycin (38.1%), imipenem (28.6%), and ceftriaxone (23.8%). Forty-seven (17.1%) of the 275 isolates were multiple drug-nonsusceptible pneumococci (MDNSP). A significantly greater number of patients < or = 12 years of age were infected with MDNSP compared with those > 12 years. Prior use of antimicrobial drugs and an immunosuppressive disorder were risk factors for infection with PNSP. In summary, pneumococci nonsusceptible to penicillin and other antimicrobial drugs are prevalent among adults with invasive pneumococcal disease in Washington State. A large proportion of PNSP are resistant to other commonly used antimicrobial drugs. Local antibiotic susceptibility data should be considered when designing empiric treatment regimens.

Antiretroviral medication compliance in patients with AIDS.

The paradigm of AIDS patient care has evolved to that of a chronic disease that is manageable with combination antiretroviral therapy. Intermittent adherence to antiretroviral regimens, however, has been associated with the selection of HIV mutations, resulting in drug-resistant virus. Medication compliance has become a vital component in the care of HIV-infected patients. This study was designed to assess the degree of medication compliance with zidovudine (ZDV) over a 2-month period among a convenience sample of 23 ambulatory patients with HIV infection. Enrollment took place during February to March 1995, when monotherapy with ZDV was considered the standard of care. Medication compliance was assessed by three methods: patient self-report determined by questionnaire, pharmacy refill records from the 3 months immediately before entry in the study, and an electronic monitoring system (Medication Event Management Systems [MEMS], Aprex Corp., Fremont, CA), which records the date and time of each opening of the medication vials. MEMS was utilized among a subgroup of eight participants over a 2-month period. Despite greater than 95% (22 of 23) of the subjects reporting that they believed ZDV was life prolonging, a majority took < or = 75% of the prescribed doses of ZDV as identified by both refill and MEMS methods. The mean percentage compliance over a 2-month period of observation for MEMS and pharmacy refill record review methods was 66% and 78%, respectively (p = 0.294). Among the subgroup of eight in the MEMS evaluation, 88% reported taking their ZDV according to the directions, all of the time. These results demonstrate that reliance upon patient self-report of medication compliance is less accurate than MEMS or pharmacy refill records, and that reliance on self-reporting could lead to erroneous assumptions of the patient's true drug compliance. In addition, the study suggests that pharmacy refill records may provide a method of assessing compliance that is equivalent to MEMS but is less experimental, and can easily be followed and interpreted by pharmacists and other clinicians caring for patients infected with HIV. Most importantly, relatively poor compliance rates demonstrated by MEMS raises serious concern for widespread development of HIV resistance to the more complicated, multiple-drug regimens in present use.

Algorithms used in adverse drug event reports: a comparative study.

OBJECTIVE: To determine if and how the Kramer and Karch algorithms differ in assigning a probability that a published case was actually an adverse drug event (ADE), and to determine if these algorithms could be used to assess published ADEs. DESIGN: Open, single-rater comparison of Karch and Kramer algorithms in 200 published ADE reports. MAIN RESULTS: The algorithms were not significantly different regarding the proportion of cases deemed definite (p = 0.5204) or probable (p = 0.2972) ADEs. The Kramer instrument was more likely to assign a possible risk of ADE (p = 0.0001), while the Karch instrument was more likely to assign a risk of unlikely (p = 0.0001). The algorithms agreed in 41% of the cases and could be used to assess published ADEs. CONCLUSIONS: The Karch and Kramer algorithms may disagree in how they assign a probability of risk to a potential ADE. This may be due to how algorithms are applied, as well as to structural differences.